I saw a television program last Thursday featuring two leading endocrinologists from Philadelphia. One doctor said it was unhealthy for women to have continuous periods and it was better to continuously take the pill (without taking the placebo pills) so that a woman would have no periods. The other doctor thought the practice was dangerous. The show featured women who have done this for more than five years (no periods!) and are very happy with the results. Is it safe to continuously take the pill without getting a period?

Dear Reader,

Your question highlights the fact that there are a range of different opinions and philosophies among health professionals regarding the practice of suppressing menstruation (a.k.a., menstrual suppression). Despite these differences in opinion, a health care provider can help you decide whether menstrual suppression is safe for you, based on your individual circumstances. Being aware of the risks and benefits of menstrual suppression is key to making a decision with which you are comfortable.

Women may have different reasons for wanting to suppress menstruation. Some may want to avoid symptoms associated with pre-menstrual syndrome, painful periods, acne, and endometriosis. Others may feel that suppressing menstruation allows them to have more flexibility in their lifestyles. Menstrual suppression can be achieved in a number of ways, after first consulting with a health care provider. One method is through “extended use” (stopping menstruation for at least two months) or “continuous use” (stopping menstruation for at least a year) of traditional birth control pills.

Other birth control pills take the “thinking” out of extended use or continuous use birth control. These include Lybrel (contains all active pills for a full year without placebo pills) and Seasonique (both which allow women to menstruate four times per year). Menstrual suppression is also possible for women who use alternative forms of contraception, including: Depo-Provera (injection form of birth control), Mirena (a type of intrauterine device), and Implanon (a birth control implant). While the NuvaRing (vaginal ring) and OrthoEvra (birth control patch) are being studied to determine whether they would be safe for extended use, the Food and Drug Administration (FDA) has not yet approved them for this purpose.

You asked about the safety of menstrual suppression. While considered to be safe, menstrual suppression is a decision best made with a health care provider. Extended cycling increases your exposure to hormones, a fact that should be taken into consideration when deciding if skipping your period is right for you. With menstrual suppression, the risks associated are similar to those experienced during the initial few weeks of pill use and include:

Breakthrough bleeding or spotting in the first few months of suppression (especially if suppressing menstruation through extended use with triphasic pills).

Not being able to tell whether you’re pregnant.

Possible post-pill amenorrhea (not menstruating after going off the pill): menstruation typically begins four to six weeks after going off the pill, but notify your health care provider if you experience amenorrhea for six months after going off the pill.

A health care provider can help decide what is right for each woman, taking into account individual circumstances. If you are considering menstrual suppression, you may want to make an appointment with a health care provider to discuss this issue. If you are a student at Columbia, you can make an appointment with a health care provider from Medical Services by calling x4-2284 or by logging in to Open Communicator.